Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4704265166 | MI |
NPI | 1033495643 |
---|---|
Provider Name | Jung Yoen Son |
First Address | Troy, MI 48084-3848 |
Second Address | Troy, MI 48084-3848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 26/10/2011 |